ADDRESS

860 THE concours for the post of Physician to the Hospitals of respect-what more is wanted (in the world outside home) Paris has just been brought to a close by the nomination of to deck with flowers the thorny ways of life ? But ’tis not on any social advantages, be they great or MM. Hutinel, Rathery, and Laudouzy. small, which may await you, I care at present to dwell ; I wish rather to utilise the brief moments at my disposal in By a decree of the 31st of May, M. Wurtz, the Professor at some of the intellectual and emotional aspects of Chemistry and Member of the Institute, has been ap- glancing under which your future occupation may be viewed. It seems mere commonplace to say that the great edifice pointed a Member of the Council of the Legion of Honour. of Medicine is built up of contributions from various SIR TREVOR LAWRENCE, BART., M.P., has consented to sciences. But underlying that commonplace is found a one bearing of which (scarcely, as a rule, conceded occupy the position of President of the Poor-law Medical truth, its due importance) I desire at this moment to insist uponOfficers’ Association, vacant by the retirement of Dr. Lush, namely, the wideness and diversity of scientific range of M.P. your pursuit. The multiplicity of cognate and allied subjects in the cultivation of which you may enjoy intellectual life, is, in fact, extreme ; you may disport yourselves in almost endless by-paths, while feeling assured you do not ADDRESS wander from the main road that leads to advanceDelivered on the occasion of the Distribution of Prizes to the really ment of your art. In this respect your profession stands Students of the Faculty of Medicine of University College, above even the possibility of rivalry. Now the scientific field which seems most naturally to on May 20th, 1879. invite occupation is that of either pure medicine or surgery. BY W. H. WALSHE, M.D. And it is needless to say that in the clinical pursuit of either of these branches of your profession lies ample scope MY LORD, LADIES AND GENTLEMEN,-On occasions like for the exercise of the most brilliant as of the most solid the present it has invariably been held to be the duty of the intellectual qualities, the observant, the contemplative, and Chairman to address some observations to the assemblage the inventive. But let us assume that, while attached to the actual art before its separation. In yielding to the time-honoured for practical purposes, you yet, for some cause or sufficiently custom I will endeavour to bear in mind that "brevity is other (say, repugnance to witnessing and dwelling on, more the soul of wit," and detain you as short a time as I reason- than absolutely necessary, the multifarious forms of human suffering), desire some other ground for intellectual recreaably may. Gentlemen students, history, we perpetually hear, repeats tion. You have the provinces of philosophical anatomy, comparative, and fossil, histology and physiology, itself, and you yourselves at this moment furnish a not human, awaiting your care, and ready to reward your toil with too fanciful illustration of the trite saying. You, like plenteous discovery. In handling Physiology, above all your predecessors of successive years, are, in regard of (while we cannot admit the doctrine that out of physiology, the event of the day, divisible into combatants and non- be it ever so sound, can be directly fashioned a reliable combatants. Now I might (catching the hint herein given, pathology), you handle an instrument of incalculable value and following high precedent) take the opportunity of in supplying a standard of comparison between the normal and the abnormal, in suggesting and giving direction to dwelling on the advantages of class competition, and, by an clinical investigations, and in explaining pathological facts easy transition, of discussing the vexed question of com- and groupings. Every truth your devotion to its culture petitive examinations in general. But, gentlemen, I look elicits will assuredly prove a direct or indirect, immediate or with little favour on a theme through which differences can remote, contribution to the knowledge of disease. Or, does your mental temperament fail to find attraction be traced between you; I had rather say my little say on a then the crucible and the alembic place themselves at here, topic in regard of which you all completely agree,-are your disposal. In Organic Chemistry, especially, you have absolutely one. What that topic is, you at once divine; an agent which is not only indispensable as an aid in you have all adopted medicine as the occupation of your scientific and pathological research, but which has proved of future lives. very material use in suggesting variations and in explaining the results of medical treatment. in can said it be Now, selecting this career, you have acted If even yet unsatisfied, you may betake yourselves to the a Can be taunted with shown unwisely? you having culture of physics, and need but recall the benefits conferred deficiency of sagacious insight into the conditions likely to on sufferers of various classes by the inventions of Neil secure you as great an amount of happiness as may, in this Arnott, to feel satisfied that in the study of Hydrostatics 46 value of tears," justifiably be hoped for? Believe one who and Mechanics an opening exists for the practical advancehas long belonged to the rank and file of the profession, ment of your profession. So, too, the science of Optics, even in its mathematical department, contains a mine of wealth, when he tells you your choice betrays no such lack of yet but partially worked, for the establishment of the laws wisdom. of certain perversions of vision. Viewing your selection from a merely social or worldly Or, perchance, the " gentle science," as it has been called, standpoint, you have embraced a calling which with well- Botany, has greater charm for your special idiosyncrasy. nigh absolute surety secures to the man who adopts it, Here, again, large opportunity exists for useful work in rewards, both substantial and sentimental, by no means to adding to the Materia Medica, and in helping to prove the be despised-that is, provided he join his profession in a of the enthusiast’s dream, that for each form of spirit of thorough earnestness and devotion, with a becoming human infirmity bounteous nature has provided a fitting sense of the grave responsibility of the work before him, remedy. Well, she may not have gone thus far, but there and provided he be prepared to follow it with unfaltering can be little doubt Mother Earth grows simples, yet unindustry and fixity of purpose. thought of, which will reward the labour of discovery and ’Tis true, the meed of State honours that awaits you is not experimentation. Or there is a department of study which (old as Hippomighty. The first Napoleon, referring to his raw conscripts douniug their new regimentals, used to say, " Each of those crates) at the present day more than ever solicits the devofellows carries a possible marshal’s staff in his knapsack !" tion of earnest men, I mean Hygienics and Sanitary Science, Now I fear I should go too far were I in like fashion to or Preventive Medicine. If here you find a congenial sphere venture on the pleasing fancy, that each of you will bear for the exercise of your abilities, public gratitude awaits away a possible patent of title attached to his diploma ; but your every effort, whether directed towards the purification I can in all truth tell you, you may achieve honourable of the air we breathe, the water we drink, the provisions we Your place as natural competence, with, as its effect, glorious, high-handed in- consume, the houses we inhabit, &c. dependence ; you may win the affectionate regard of those! leaders in all work of this description is at least recognised by on whom your skill is exercised ; and, ever treading in the! the nation; you will not toil without acknowledgment of paths of honour, you may, nay will, command personalL your services. What a change from a time not so far rerespect equal to that enjoyed by any member of the circle: moved from the present hour, when I remember to have read in which destiny may cast you. Competence, affection, in one of the lay quarterlies that sorre project of sanitation, _____________

justness

,

861

public, was vitiated by one radical defect- thither ; that if he chooses to penetrate this further region namely, that it was proposed medical men should take part of inquiry, he does so merely as an amateur, free from in carrying out the necessary measures. "How," remarked scientific responsibility. For speculation, of at once the the generous and far-seeing critic, " how could it be ration- most ambitious and the haziest type, cloaking uncertainty ally expected that a body of men, who live by disease, would only too absolute, would, judging from the achievements of take a serious part in extirpating it ?" The only evil I will other classes of scientists, prove the sole result of his migrawish our thoughtless traducer is that he may have lived to tion into these realms of intellectual darkness yet more then before the

Cimmerian than his own. the error of his ways. But are we, physiologists and pathologists, worse off, less But the quality of your minds may not easily adopt itself - may be actually antagonistic-to any one of these varieties bewildered, in our own special provinces, than the devotee of work, except the mathematical. Your minds may be of of even the exact sciences occasionally finds himself ? Take the most positive among the positive types; you may in- the astronomer, who, as he peers on a star-lit night into the stinctively shrink from dealing with questions tainted with depth of the heavens, descries within telescope range countless suns lost so far away in the unfathomable regions an element of uncertainty-questions to which the answers can, at the best of times, prove little more than intensely of space, that their light (assuming that it travels at the Then imitate William Farr, whose mind was same rate as that emitted by our own sun, about 190,000 moulded precisely after this fashion, and betake yourself to miles in a second) would require thousands upon thousands Medical Statistics. Manipulate integers representing for of years to reach his eye-who, warranted by inference, to you, with a certainty that may not be challenged, facts of which no logical objection can be urged, accepts as fact that turn them, twist them, set them side by side in like solar systems exist beyond and beyond and yet beyond varied aspects connected with age, sex, season, locality, oc- all these his comparatively feeble instrument can reveal, cupation, density of population, and so on indefinitely, and themselves launched in a universe to which there is neither beginning nor end-who feels that he is in the presence of you still work in the legitimate realm of medicine. Or are you endowed, by chance, with a love of the study infinite Space and infinite Matter in infinite Time, and asks of physical nature-land and sea, mountain and valley, himself, What is in Infinity ? The problem forces itself upon river and lake : you may indulge your fancy to the top of him. With a craving anxiety, almost savouring of mental your bent, and utilise it to the scientific and practical ad- torture, he strives to solve it ; but solution to the stupendous vantage of Physic. You may, like Arthur Haviland, con- enigma there is none ! The moment he attempts to travel tribute to an enlarged knowledge of the geographical dis- from finite space, on which his marvellous calculations are tribution of disease ; or, like George Buchanan, succeed in habitually worked, to the infinite beyond, his power is anthrowing light on its etiology by investigating the influence nulled. His mind, with its existing dynamism, and subof various soils ; or, in concert with numerous workers at served only by the five senses assigned the dwellers on this home and abroad, add new facts in elucidation of that poor earth, in their present phasis of evolution, is incapable intricate problem, the influence of climate on the progress, of conceiving the Infinite, even in the rudest and most hypofor evil or for good, of various maladies. thetical manner. Both for astronomer and physiologist Or, to cite one more illustration, has nature gifted you "there are more things in heaven and earth than are with the aspiration and the power to grapple with the dreamed of in our philosophy !" Let the failure teach us humility. What are we that we phenomena of Mind ? - is the bent of your talent metaphysical? Seize, then, the seductive opportunity, afforded should rebel against the limitation of our knowledge, when through your familiarity with the physiology and pathology Newton himself was content "to pick up pebbles on the of the brain, of submitting to the test of an objective expe- shores of the great ocean, Truth"? We must not murmur rience the subjective results of the metaphysician’s intro- that it is our lot to furnish a goodly contribution to the spection. So will you aid in showing that the psychological "Unknowable"" of Herbert Spencer! Nay, more: there method of interrogating self-consciousness, as a factor of a may be wisdom, as assuredly there is comfort, in the notion, complete system of mental science, must look for supple- urged by a German physiologist, that it is rather the mentary help to the study of facts, taught by observation of struggle to attain truth, than the actual amount of truth the brain action of others, nor ourselves, in health and dis- possessed, that exalts intellectual manhood. " Were the In a word, seek for work in that tempting border- Deity," says this unfettered thinker, " to place in his right ease. land lying between Metaphysics on the one hand and hand all truth, and in his left only the abiding, never sleepCerebral Physiology and Pathology on the other. There ing, yearning desire to obtain truth, and offer me the choice, e you will find Henry Maudsley has planted his standard, and I should humbly turn me to the left, and say,’Father, give brilliantly possessed himself of the previously well-nigh me this; pure truth is fit for thee alone"’ ! unbroken ground. But he, probably more readily even than The emotional aspects of your profession have been "sung others, would admit there may be found abundant acres yet by loftier harps than mine"; I will not risk the marring of uncultivated in his scientific domain, and welcome you as their harmonies by any harsh strains of my own. In lay co-labourers to their tillage. authors, I need only remind you, you may read of the deep But whichever be the path selected wherein to expend and solemn delight you are entitled to feel when you have your mind’s activity, your goal will be truth, as far as ac- demonstrably been the agents in saving or in prolonging cessible. All truth, absolute truth, is probably not within life-of restoring one deemed wellnigh lost to those who man’s reach in any department of the sciences of observa- love him. You are told with gratitude how you staunch the tion, confessedly not in that of medicine. For example, the soldier’s life-blood on the battle-field, and deftly cure his physiologist would doubtless delight to know, with a quasi- wounds so that he may live; though it were better saidmathematical precision, how, in the workshop of the brain, as one of our own craft, Ambroise Pare, in days of yore, thought is manufactured; what dynamic struggles, what more modestly put the facts-" Dress his wounds, while chemical decompositions and recompositions, what physical God cures them." The citizens you save every now and tissue-changes are essential, as tertiary conditions, to the then to the State, by tracing out a new and healthful career elaboration of an idea. So, too, the pathologist would for him, whose present way of life, you divine, must lead to gladly present his little claim to know, with minutest ac- premature death and decay, are spoken of as abiding witcuracy, what comes of these various processes in delirium, nesses to your skill. Nor is credit withheld you as mitihallucination, mania, delusion; are these processes modified gators of the wretchedness of pain; or, if no more be posmerely in intensity, in combination, in co-ordination ? Or is sible, as smoothers of the passage which leads to that there a something absolutely new in the physical and chemical " bourne whence no traveller returns." All these links between yourselves and suffering man furbrain-perturbations tributary to the production of a madman’s thoughts ? But with all these phenomena, we possess nish emotional attraction to the exercise of your art ; through at the present hour only a most imperfect and purely tenta- them you succeed in lending aid, slender though it be, tiveacquaintance. And fortunate it is for the physiologist towards lightening the wellnigh unbearable load of misery that his actual responsibility ceases with their statistical which weighs down our race, and which has made Pessimism, element. Fortunate it is for him that the determination the dismal faith of Schopenhauer, a possible philosophic and analysis of the non-material force, or secondary spiritual creed. And might I here take the opportunity of saying a few cause, which (obeying the fiat of the Great First Cause) touches, as it were, the spring that brings into effective play words on a field for sympathy rather neglected than otherthat wondrous mechanism, the outcome of whose activity is wise ? I mean the sufferings of so-called "nervous patients." thought, lies beyond his province. Well may he congratulate " People with nerves -that is, people the victims of various himself that his legitimate and enforced task extends not neuroses-because all means of objective investigation fail see

probable.

disease ;

862 to detect structural flaw in their organs, are complacently status as hypochondriacs, and thenceforth ofttimes denied all, or grudgingly doled out the scantiest, commiseration. Let meimplore you not to be thus unjust ; try to believe that these sufferers may know their own feelings better than you can guess them, that their be wiser than your negations, that their affirmations

assigned a nosological

may

stories of indefinable torture, besetting them by day and sometimes leaving them little respite by night, may be only

too literally true. Though I cannot, out of my own knowledge, on the one hand, wholly agree with Claude Bernard, nor on the other distinctly refuse to follow him in the doctrine that innervation is always the primary dominant power in disease, as in health, still, I feel clinically certain that what I may call the imponderable element of morbid action, that is, perverted innervation-nerve gone astray - holds the governing place within the range as a regulator of human misery. Compare the man who labours under a structural de-

pathological fect of his you

heart, that may even as he stands before kill, and who (his cardiac nerves being tranquil)

smiles incredulously if the integrity of the organ be in the faintest fashion challenged-compare this man with another whose heart issues from the most patient physical scrutiny as a piece of perfect structure and mechanical adaptation, while his life is, in point of fact, rendered one unbroken misery by disordered innervation of the organ, and his conviction remains unshakable, in spite of all your protestations to the reverse, that its texture is profoundly diseased. The latter is a man claiming your gentlest and truest sympathy, and, though on different grounds, as justifiably as the former. Above all, do not, as some pathologists have striven to do, place him in the category of the mildly insane ; call his nerves insane, if you will; but his brain is often, unfortunately for himself, only too sane. And I do not stand alone in pleading the cause of these sufferers; the late James Johnson, and, yet more earnestly, Russell Reynolds, have written eloquent words in their behalf. Before concluding, gentlemen, I should wish to say a few words on the manner of your work. A long intercourse with my fellow-men has led me to the conclusion (despite the well-known stories of Bichat, Porson, and a few such exceptional and brilliantly gifted men) that steady moderate industry achieves greater results than fitful application of the severest kind. ’Tis not the man who wastes weeks or months in frivolous amusement, and then makes up for lost time by spasmodic efforts of fierce labour-the midnight oil burning before him, the black coffee by his side, cloths steeped in vinegar cooling his fevered brow,-’tis not this man who succeeds in raising himself to eminence, or in adding his mite to the sum of previously acquired knowledge. No ! ’Tis the steadfast toiler, who never wastes the day he cannot recall, who (in the fashion that Titus of old marked each day by an act of goodness) never allows twenty-four hours to slip away without having performed his act of work,-who "hives wisdom with each studious day." ’Tis the old story of the perpetual drop, drop, drop, eating its way through the rock, while violent occasional torrents pass over its surface, leaving its substance unscathed. I was greatly interested some while ago at hearing from the lips of a philosopher who is not only one of the foremost and deepest thinkers in Europe, but one of those who has produced most veritable work, that he limits his time of actual application to a very few hours daily; but then, from the first to the last of the year, each day (no matter what be the attraction otherwise) is made to furnish its contribution of toil. Gentlemen, the logical methods adopted of late years in the study of medicine have attracted the attention of the lay world, and every now and then, even in the columns of the political press, are made the theme of praise and held up as models for imitation. Beyond all reasonable question this homage is mainly paid us because we have learned to substitute the authority of facts for the authority of persons, and ceased to regard mere theories as deserving of recognition except as suggestive of inquiry. In the field of literature the satire of Moliere, which left few of the follies of his time untouched, fell heavily on this worship of personal authority, in lines which may be freely, though

feebly,

rendered thus :-

All that talk was trash, Coming from a Nobody; ’Twould have been exquisite sense, Had it been said by a Somebody!!

Time was, and recently, too, when in medicine, as in literature, personal authority reigned supreme; the smart saying "rather be wrong with Scaliger than right with the first comer" was generally accepted as the true guide to

scientific judgment. We of the latter half of the nineteenth century have signally reversed all this : our motto is " infinitely rather be right with an unknown man, provided he brings us his budget of facts, than pin our faith on the unproven assertion of a host of Scaligers." The trammels of prejudice and authority have, in truth, been rent asunder; the tyranny of stereotyped ideas is dead. Csesarism in science, as in politics, we have learned to abjure with all our souls. In this matter I need only counsel you, Be of your time. Enlist your powers, as the slaves of fact, in the service of observation. Cultivate sedulously your observant faculties, remembering it is perhaps even more difficult to observe facts faithfully than to reason justly on well-observed facts. Shrink from the acceptance of theories and hypotheses as proven truths and grounds of action, be they ever so plausible, ever so ingenious, ever so apparently true, and be their paternity ever so distinguished. Let your guide to scientific faith be found in the oft-quoted thought of Goethe :Grey is all theory, And green the golden tree of life ! Engraft on this faith entlzusiasm (that galvanic battery of the intellect), which vivifies power, where it exists, and even summons it into being where it is not. It remains for me to tender my thanks to the Council for the honour done me in inviting me to preside to-day. None can know better than myself that their invitation had no warranty in any particular fitness of mine for the office ; I feel simply that in applying to one who formerly filled a chair in the College they were desirous of exhibiting their wish to tighten yet further the bonds of amity, always. closely knit, that exist between themselves and the professorial body. Nor can I forget my quondam colleagues who so cordially received the Council’s nomination, and yet not precisely the colleagues of old. I miss the shrewd and genial smile of the wise and learned Sharpey ; the patient, accurate, and earnest Ellis no longer guides the scalpel of the young; Grant, he who, with a novel zoophyte before him, felt greater than a monarch, is seen no more; the gentle and winning devotion of Parkes has ceased to smooth away the difficulties of the zealous worker. But if these men of mark have disappeared from among us-are no longer here to dignify by precept and example the offices they filled-others have succeeded to places as able as they to expound the doctrines of the their sciences they profess, and instil into those they teach a love of that which is taught. In truth, University College seems to possess the happy faculty of attracting to its fold an everincreasing mass of intellectual power. The props of the edifice appear to strengthen as years roll on ; the edifice itself, sacred to freedom of conscience and of intellect, must endure ! And that it may so endure, that its academic lustre may ever brighten more and more, is the fervent hope of him who has now addressed you. .

HEALTH OF LARGE ENGLISH TOWNS IN THE

TWENTY-THIRD WEEK OF

1879.

DURING last week 4333 births and 2785 deaths were registered in twenty of the largest English towns. The births were 849, and the deaths as many as 585, below the average weekly numbers during 1878. The deaths showed a further decrease of 118 from those returned in recent weeks. The annual rate per 1000, which in the thirteen preceding weeks had declined from 29’1 to 20’5, further fell last week to 19’7, a lower rate than has prevailed in any week since the middle of June last. The lowest rates in these towns last week were 14’7 in Plymouth, 1G’3 in Brighton, 16’8 in Hull, l7’2 in Sheffield, l7’4 in Wolverhampton, and 17’8 in Sunderland. The rates in the other towns ranged

upwards to 22-0 in Leicester, 22’I in Manchester, 23’2 in Bradford, and 23’4 in Oldham. The deaths referred last week to the seven principal zymotic diseases in the twenty towns

were

than those returned in the included 102 from measles, 79 from 72 from scarlet fever, and 35 from fever,

369, and

previous week; they

whooping-cough,

one more